C61: Malignant neoplasm of prostate

The ICD-10-CM code for an active malignant neoplasm of the prostate, of any histology, when the disease is being treated, managed or monitored at the encounter.

Billable

FY2027

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At a glance

Code Family

C61: Malignant neoplasm of prostate.

Condition

Prostate cancer

Billable

Yes. C61 carries no child codes and requires no further characters.

HCC Mapping (v28)

HCC 23: Prostate, Breast, and Other Cancers and Tumors.

DRG Grouping

MS-DRG 722, 723 or 724 (Malignancy, Male Reproductive System) as principal diagnosis under the FY2027 MS-DRG v44 grouper. With a qualifying O.R. procedure, MS-DRG 715 or 716 can apply.

Effective Date

Valid in the FY2026 code set and unchanged in the FY2027 update.

Which C61 code do I assign?

ICD-10-CM carries one code for every malignant neoplasm of the prostate, whatever the histology, grade or stage. The decision is therefore not which C61 code to assign but whether the documented finding is an active prostate malignancy at all.

When documentation says…

Code

Confirmed malignant neoplasm of the prostate, under treatment or monitoring

C61

Active prostate cancer of any histology, including adenocarcinoma, small cell carcinoma and carcinoma NOS. The note must document the malignancy as a confirmed diagnosis and show that the disease is being treated, managed or monitored.

Treatment completed, no active disease

Z85.46

Personal history of malignant neoplasm of prostate. Assign this when the cancer was excised or eradicated, no further treatment is directed to the prostate and no existing malignancy remains (Guideline I.C.2.m). A surveillance visit after completed treatment lists Z08 first and Z85.46 second (Guideline I.C.21.c.8).

Elevated PSA, no confirmed malignancy

R97.20

Elevated prostate specific antigen with no confirmed cancer diagnosis. The record must show the abnormal laboratory finding without a provider diagnosis of malignancy.

Carcinoma in situ of prostate

D07.5

In situ disease, which has not invaded beyond the basement membrane. The pathology report must state in situ rather than invasive disease.

Benign prostatic hyperplasia, no lower urinary tract symptoms

N40.0

Benign enlargement of the prostate. The note must document the hyperplasia as benign. N40.0 is also the default when the record does not document lower urinary tract symptoms. Where those symptoms are documented, assign N40.1.

Malignant neoplasm of seminal vesicle

C63.7

Malignant neoplasm of other specified male genital organs, the category to which seminal vesicle malignancy is classified. An Excludes1 note prevents this from being reported with C61 for the same condition.

Prostate primary with documented bone metastasis

C79.51

Secondary malignant neoplasm of bone, assigned in addition to C61 rather than instead of it. The note must identify both the prostate primary and the metastatic site.

Tabular notes

EXCLUDES1

Malignant neoplasm of seminal vesicle is classified to C63.7. The seminal vesicles are anatomically distinct structures from the prostate. An Excludes1 note means C61 and C63.7 cannot be assigned together for the same condition.

USE ADDITIONAL

Use additional codes to identify hormone sensitive malignancy status (Z19.1), hormone resistant malignancy status (Z19.2) and rising PSA following treatment for malignant neoplasm of prostate (R97.21). The tabular qualifies the note with the words if applicable. Report each code when the finding is documented.

FY2027: EFFECTIVE 1 OCTOBER 2026

The FY2027 codes and tabular addenda make no addition, deletion or revision at C61 or in block C60-C63. C61 is in the FY2027 code set and is unchanged in the FY2027 update.

Operational & financial impact

Why specificity matters beyond the chart: risk adjustment, DRG assignment and denial exposure all follow from which code is selected.

CMS-HCC v28 (PY2024+)

HCC 23: Prostate, Breast, and Other Cancers and Tumors.

CMS-HCC v28 is fully operative at 100 percent weight for Medicare Advantage payment year 2026.

The HCC 23 category name does not name prostate cancer. The CMS mapping tables are authoritative for determining which codes map to HCC 23.

HCC capture requires C61 to appear in clinical documentation during the data collection year. Calendar year 2025 documentation supports payment year 2026.

V24 TO V28 TRANSITION

In CMS-HCC v24, C61 mapped to HCC 12, Breast, Prostate, and Other Cancers and Tumors.

The v28 model maps C61 to HCC 23.

HCC 23 is the operative category for payment year 2026.

WHERE SPECIFICITY IS LOST

Coding Z85.46 while treatment is still directed to the prostate, or for an untreated cancer under active surveillance, removes C61 from the data collection year. The HCC 23 mapping is not captured for that year.

Omitting Z19.1 or Z19.2 when hormone sensitivity status is documented drops the treatment context from the claim.

Omitting C79.- secondary site codes when metastatic disease is documented understates the extent of disease.

MS-DRG v44 (FY2027)

MS-DRG 722: Malignancy, Male Reproductive System with MCC.

MS-DRG 723: Malignancy, Male Reproductive System with CC.

MS-DRG 724: Malignancy, Male Reproductive System without CC/MCC.

A medical admission with C61 as the principal diagnosis groups to MS-DRG 722, 723 or 724 under the FY2027 MS-DRG v44 grouper.

With a qualifying O.R. procedure, the case groups instead to the surgical pair in MDC 12. MS-DRG 715: Male Reproductive System and Other O.R. Procedures for Malignancy with CC/MCC. MS-DRG 716: Male Reproductive System and Other O.R. Procedures for Malignancy without CC/MCC.

C61 is not classified as a Complication or Comorbidity or as a Major Complication or Comorbidity under MS-DRG v44 definitions.

Medicare and commercial payers

There is no National Coverage Determination specific to the diagnosis code C61.

Annual visits, oncology follow-up and medication management encounters should document the active cancer diagnosis where it remains relevant to care.

Documentation checklist to support C61

Chart elements that support code selection and reduce specificity-driven denials.

Provider documentation of prostate cancer as a confirmed diagnosis.

Evidence that the disease is active, meaning it is being treated, managed or monitored at the encounter.

Hormone sensitivity status where it has been determined, to support Z19.1 for hormone sensitive disease or Z19.2 for hormone resistant disease.

Rising PSA following treatment where it is clinically relevant, to support R97.21.

Whether the disease is confined to the prostate or has metastasized. Metastatic sites are coded with C79.- in addition to C61.

The reason for the encounter, which determines whether C61 is sequenced as the principal diagnosis or as an additional diagnosis.

A dated encounter note in the data collection year, since HCC capture requires C61 to appear in clinical documentation for that year.

FAQ

Is C61 a billable code?

Yes. C61 is a billable ICD-10-CM code in the FY2027 code set, effective 1 October 2026. It carries no child codes and requires no further characters. Histology, grade and stage are not represented through code expansion for prostate cancer. They are documented in the medical record and the clinical registry.

When do I use Z85.46 instead of C61?

Use Z85.46, personal history of malignant neoplasm of prostate, when the cancer was excised or eradicated and no further treatment is directed to the prostate. There must also be no evidence of existing malignancy there (Guideline I.C.2.m). C61 stays while treatment continues and for an untreated cancer under active surveillance. At a surveillance visit after completed treatment, list Z08 first and Z85.46 second (Guideline I.C.21.c.8).

Does C61 map to a Medicare HCC?

Yes. C61 maps to HCC 23, Prostate, Breast, and Other Cancers and Tumors, under CMS-HCC v28. That model is fully operative at 100 percent weight for payment year 2026. The category name does not name prostate cancer. The CMS mapping tables are the authority for which codes map to HCC 23.

What has to be documented to support C61?

The record has to document four things: active prostate cancer stated as a confirmed diagnosis, hormone sensitivity status where it has been determined, rising PSA following treatment where it is clinically relevant, and whether the disease is confined to the prostate or has metastasized.

How do I sequence C61 for metastatic prostate cancer?

Code C61 for the primary site and add the secondary site code, such as C79.51 for bone metastasis. Under ICD-10-CM Official Guidelines Section I.C.2.b, sequence the secondary site as principal when treatment is directed toward the secondary site only. C61 carries no Code First instruction. It may be sequenced as the principal or as an additional diagnosis based on the reason for the encounter.

Can C61 and C63.7 be reported together?

No. C61 carries an Excludes1 note for malignant neoplasm of seminal vesicle, which is classified to C63.7. An Excludes1 note prohibits reporting both codes for the same condition. The seminal vesicles are anatomically distinct from the prostate.

Does C61 behave differently on the inpatient side?

C61 may be the principal diagnosis when the admission is for prostate cancer treatment or management. As principal diagnosis on a medical admission, C61 groups to MS-DRG 722, 723 or 724 under the FY2027 MS-DRG v44 grouper. With a qualifying O.R. procedure, the case groups instead to MS-DRG 715 or 716. On the outpatient side, code C61 at any encounter where active prostate cancer is being managed, treated or monitored.

Did C61 change in FY2027?

C61 is unchanged in the FY2027 update. The FY2027 update, effective 1 October 2026, makes no addition, deletion or revision at C61 or in block C60-C63.

Related codes

Codes in the same family as C61. Only codes with a published page render as links.

Sibling codes in the C61 family

C60.0–C60.9: Malignant neoplasm of penis.
C62.00–C62.92: Malignant neoplasm of testis.
C63.7: Malignant neoplasm of other specified male genital organs.
C63.8: Malignant neoplasm of overlapping sites of male genital organs.
C63.9: Malignant neoplasm of male genital organ, unspecified.

Additional codes to consider

Codes outside the C61 family considered alongside C61.

Companion: code alongside when documented

Z19.1: Hormone sensitive malignancy status.
Z19.2: Hormone resistant malignancy status.
R97.21: Rising PSA following treatment for malignant neoplasm of prostate.
C79.51: Secondary malignant neoplasm of bone, where bone metastasis is documented.
C79.89: Secondary malignant neoplasm of other specified sites.

Consider instead

Z85.46: Personal history of malignant neoplasm of prostate, where the cancer was excised or eradicated, treatment is complete and no existing malignancy remains.
Z08: Encounter for follow-up examination after completed treatment for malignant neoplasm, listed before Z85.46 at a surveillance visit under the Z85 Code first note.
D07.5: Carcinoma in situ of prostate, where the pathology states in situ rather than invasive disease.
R97.20: Elevated prostate specific antigen [PSA], where no malignancy has been confirmed.
N40.0: Benign prostatic hyperplasia without lower urinary tract symptoms.
N40.1: Benign prostatic hyperplasia with lower urinary tract symptoms.
C63.7: Malignant neoplasm of other specified male genital organs, the Excludes1 partner covering seminal vesicle.

Sources

All claims on this page derive from government and professional-standards sources.

National Center for Health Statistics. (2026). International classification of diseases, tenth revision, clinical modification (ICD-10-CM) FY2027 files. https://www.cdc.gov/nchs/icd/icd-10-cm/files.html
Centers for Medicare & Medicaid Services and National Center for Health Statistics. (2026). ICD-10-CM official guidelines for coding and reporting FY2027. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2027/ICD-10-CM-October-1-2026-FY27-Guidelines.pdf
Centers for Medicare & Medicaid Services. (2025). 2026 model software/ICD-10 mappings. https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/2026-model-software-icd-10-mappings
Centers for Medicare & Medicaid Services. (2026). MS-DRG classifications and software, version 44. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software